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Influenza A Pandemic
PERKIRAAN KORBAN
1918 1919 : P.D. I : 8,3 sementara Pandemi : 40
1957 1958 : lebih 2 Juta
1968 1969 : 1 juta
Influenza A Pandemic
FromHayetalPhilTransR
SocLondon(2201)356:1861
Influenza A Pandemic
Subtype: H, Hemagglutinin; N, Neuraminidase
Netherlands, etc
H7N7
H1N1 H5N1
1968 1977
H9N2
H5N1
1997
1999 2003
2004
H5N1
Duck
Pig
H1N1, H3N2
Chicken
H5N1
Quail
H9N2
Equine
influenza
Cattle (2002)
Host Range
Restriction
No Report
H1 H15
N1 N9
Human influenza
H1N1(1933,1979) H5N1(1997,2003)
H2N2(1957) H9N2(1999)
Whale influenza
H3N2(1968) H1N2(2002)
H3N2 H13N9
H7N7
H3N8
Ferret influenza
H10N4
Duck
Human
Swine influenza
H1N1 H3N2
H1N2
H4N6(2000)
H5N1 (2004)
Concern on virus re
assortment
Migratory
water birds
Poultry
Source: WHO/WPRO
PANDEMIC
1. Reduce
opportunities for
human
infection
Support the FAO/OIE control strategy
Intensify collaboration between the
animal and public health sectors
Strengthen risk communication to
rural residents
Improve approaches to environmental
detection of the virud
2. Strengthen the
early warning system
3. Contain or delay
spread at the source
4. Reduce morbidity,
mortality and social
disruption
Monitor the evolving pandemic in real
time]
Introduce non pharmaceutical
interventions
Use of antiviral drugs to protect priority
groups
Augment vaccine supplies
Ensure equitable access to vaccines
Communicate risks to the public
5. Conduct research to
guide response
measures
Japan
Vietnam
Thailand
Cambodia
China
Indonesia
Laos
H5N1 in Human
Vietnam
Thailand (2004)
CFR <5 yrs (50%)
5-14 yrs 7/7 (100%)
Jlh
CFR
Vietnam
Mgl ks
100
Thailand Cambodia
Mgl ks
Mgl ks
91 45 17 12
45
71
Mgl
100
Total
ks
Mgl
114 59
52
AI outbreak in poultry
(diagrammatic) and human cases,
Thailand Oct 2003 Aug 2004
Detection by
Detection by cloacal
swab surveysPCR /
viral isolation for H5
Stamping out in 5 km
Surveillance in 50 km
Movement restriction
Total culling 30+ mill.
Outbreak
in poultry
clinical criteria
deaths > 10%
Stamping out in
suspected farm
Surveillance in
1 km
Movement
restriction
Total culling
0.7 mill.
Human
cases
2003
2004
Remaining/
moving sources
Reintroduction by birds?
15 Sep 04
Septicaemia
Spreading invasive
infection
Local infection/critical colo
nisation
Colonisation
Contamination
CARA PENULARAN
INFEKSI
Contact Transmission/Man-to-man
Transmission
Droplet Transmission : Percikan mengandung
mikroorganisma yang disebarkan dalam jarak
dekat (1 2 meter) melalui udara
Airborne Transmission: Menyebar melalui
residual particle < 5 um dan tetap berada dalam
aliran udara untuk waktu cukup lama
Common Vehicle Transmission : melalui
makanan tercemar, air, alat kesehatan
Vectorborne Transmission : nyamuk, lalat,
tikus dll.
INFECTION
probability(kemungkinan infeksi) =
DOSAGE (dosis infeksi) X
SUSCEPTIBILITY (kepekaan
manusia) X TIME (waktu) X
VIRULENCE (keganasan
mikroorganisme) X HOST DEFENCE
(daya tahan tubuh manusia)
Infected
n
o
i
poultryat n
e
nc
Outbreak control
in poultry,
prevention
Infected
birds of
new
infection
in nature
lla
ei
rv
Su
public information
se
in operation and
n
a
io
se
ct s
Di
fe p
in ou
of gr
n sk
tio -ri
ec h
ot hig
Pr in
Transparency
Man
t l
n
e tro
m n
m tio
e
r
g co
o a
a
f
n n
in uc
a
d
il c e
m ctio
e fe
b d
s
u
a
P an
C d in
an
11/10/16
(alkohol 70%)
APP (sarung tangan,kacamata,masker dll)
Vaksinasi virus flu manusia bagi yg terpajan
dengan tujuan agar tidak terjadi dua infeksi
gabungan virus flu manusia dan flu burung
dalam satu orang yang memungkinkan
timbulnya strain baru virus flu burung yang
dapat ditularkan dari manusia ke manusia
Mereka yang rentan (anak-anak, orang usia
lanjut, penderita penyakit jantung, paru
kronis) agar menghindari tempat jangkitan
(peternakan unggas dll)
Pencegahan (lanj.)
Definisi Surveilans
Surveilans Highly
Pathogenic AI
11/10/16
Surveillance
& Lab.
investigation
Investigation
Contacts
Report
A case
Hospital
Diag.
Treat. /IC
Case management
General pop. &
Risk groups
Prevent risk
exposures
Reduce risk
factors
Poultry and
birds
IE&C
Discharged
Pekerja peternakan/pemrosesan
unggas (termasuk dokter hewan/Ir
peternakan)
Pekerja laboratorium yang memproses
sampel pasien/unggas terjangkit
Pengunjung peternakan/pemrosesan
unggas (dlm 1 minggu terakhir)
Kontak dengan penderita flu burung
Penularan
8 April 2003
Kasus SARS
Di RSPISulianti
Saroso
Pneumonia
atipikal
Pneumonia
Typical
Pneumonia
Atypical
Pneumonia
Influenza A (H5N1)
Pneumonia
Uji laboratorium
Manajemen kasus
Definisi kasus:
Manajemen kasus
(lanj.)
Probable Case
Possible case DAN
Hasil laboratorium tertentu untuk
virus influenza A (H5N1) IFA, dgn
H5 monoclonal antibody ATAU
Tidak terbukti adanya penyebab lain
Manajemen kasus
(lanj.)
TATALAKSANA
Alat Pelindung
Perorangan(APP)
Cuci tangan
Masker N95, minimum masker bedah
Pelindung wajah / kaca mata google
Apron/gaun pelindung
Sarung tangan
Pelindung kaki (sepatu)
TERAPI